Like every psychiatrist, I have patients whose antidepressants are transformative and even lifesaving. But I also see the messy and publicity side of these drugs. There are patients with sexual side effects that they are not aware that may be caused by antidepressants, as previous doctors have never warned them. I have patients experiencing a manic attack or suicidal thoughts with specific antidepressants and no longer need to take medication, but they experience severe withdrawal symptoms when they try to gradually relieve them.
The medical community was surprised by the statements of Health Secretary Robert F. Kennedy, whose family is harder to get rid of antidepressants than heroin. The American Psychiatric Association and five other psychiatric organizations recently announced that it is “misleading” to compare antidepressants to drugs that arrange drugs like I drugs like heroin, and stressed that antidepressants are “safe and effective.”
But some patients heard Mr. Kennedy’s comments and thought that the person who finally spoke to them had finally spoken for them. On the online forum, dedicated to helping people exit antidepressants, such as surviving antidepressants, patients described “revoked” and went through “pure hell” in an effort to get rid of the medication.
They saw in Mr. Kennedy that after years of neglect in the medical community, he was wary of the severity of the problem, for which their experiences might be relatively rare, or that Mr. Kennedy’s health movement ignores science and contains health movements against vaccine ideology, unlikely to serve the best interests of the patients.
Selective serotonin reuptake inhibitors, or SSRI (the most common form of antidepressant) were initially studied for short-term use and approved based on trials that lasted only a few months. But people quickly started taking drugs for a long time. Now, patients may continue on antidepressants for years, or even decades. Among those who attempt to quit, conservative estimates suggest that about one in six experience antidepressant withdrawal, and about 35 suffer from more severe symptoms. It is estimated that protracted and disabling withdrawals are far less common than that. Nevertheless, even relatively rare complications can affect thousands in a country where more than 30 million people take antidepressants.
That's a weird reason why nearly four decades after Prozac's approval, there is no high-quality randomized controlled trial that guides clinicians to safely shrink patients from antidepressants. Lack of research also means There are few official guides in the United States. Not surprisingly, patients have flocked to online communities to develop their own strategies, sometimes cutting pills into smaller and smaller sections to gradually reduce doses over months and years.
For many patients, starting with antidepressants is obviously worth it. There is strong evidence that antidepressants are more effective than placebo, especially for short-term use. However, as for most drugs, the effectiveness of antidepressants varies from person to person. Nearly one-quarter to one-third of patients found that their depression was significantly improved or even resolved after starting medication, but even with multiple antidepressants, there was no similar proportional experience.
Given the conventional long-term use of antidepressants, we need to see if the effects on the drug wear out over time, or if some patients suffer more from long-term use than others. But pharmaceutical companies are unlikely to conduct the study: they have no regulatory obligation to study these things, and the costly and adverse findings may damage the reputation of the drug. Meanwhile, federal funding has prioritized basic research to the causes of mental illness or drug development rather than various problems that arise in medical practice, such as how to alleviate the sexual side effects of drugs.
Patients with antidepressants are often more likely to experience recurrence of depression symptoms than those who are constantly using antidepressants. But is it because their underlying depression is returning, or is it because they are exiting? It's hard to know. One of the best studies found that 39% of people living with antidepressants suffered from worsening depression over the course of a year, while 56% of people living with antidepressants suffered from depression.
For many, the 17-percent difference in the risk of depression is worth staying on the medication. For others, this may not be, especially when they have major side effects from antidepressants, such as inability to orgasm, mood bluntness, and weight gain. On the other hand, many of my patients with chronic depression and anxiety problems reported feeling more resilient when they were antidepressants and being able to cope with stress better. In this case, I'm glad they were able to use the medication for a long time.
President Trump recently issued an executive order calling for the establishment of a Chronic Disease Commission led by Mr. Kennedy, which will investigate the “threat” posed by SSRI to young people. The committee is scheduled to provide its initial report this month. Like many other doctors, I have reservations about the government’s ability to strictly learn treatment given their records of disregarding medical evidence and Mr. Trump’s preference for assigning leadership roles based on ideological loyalty rather than scientific certificates. As the National Institutes of Health is affected by staff cuts and stagnant grants, private research funding organizations need to step up efforts and make research on drug safety a research priority.
The public should get advice on psychotropic drugs that do not oscillate between drowsiness and alarm. Like all medical interventions, antidepressants come with benefits and trade-offs. If psychiatry refuses to take the patient’s concern seriously, then if the “safe and effective” mantra is willing to be said publicly, it will lose credibility. We cannot ignore those who are derailed by psychiatric drugs.
This political era revealed that victims would rather burn the system on the ground than tolerate institutions that do not speak out everyday reality. The question is whether healthcare institutions will meet demand with humility and scientific transparency, or leave conversations to those willing to exploit the suffering of disadvantaged individuals.
